urinary system and male genital system. cpt® copyright 2012 american medical association. all...

Urinary System and Male Genital SystemUrinary System and Male Genital System

Urinary System and Male Genital System

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT®, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT® is a registered trademark of the American Medical Association.

• Describe the anatomy of the urinary system• Describe the anatomy and functions of the male reproductive

system (the female reproductive system is covered elsewhere)• Understand the structures and processes that form and eliminate

urine• Understand and learn where to locate diseases specific to the

urinary system within ICD-9-CM• Learn the components of the CPT® manual specific to the

genitourinary system and male genital system• Determine when and how to apply modifiers• Discover which HCPCS Level II codes are significant to the

genitourinary system

Objectives

• Two kidneys (filters)• Renal pelvis/one per kidney (funnels urine into

ureters)• Two ureters (to bladder)• One bladder (storage)• One urethra (exit)

Nephro = kidneyRenal = related to kidneyPyelo = renal pelvis

Anatomy: Urinary System

• Kidneys– Retroperitoneal (behind the peritoneal cavity)– Right kidney

• Liver is Superior and anterior to the right kidney• 12th thoracic vertebrae

– Left kidney• Contact with spleen, pancreas and stomach• Contact with the 11th rib

– Andrenal glands sit on top of the kidneys

• Diseases of Kidneys & Ureters– Atrophic kidney– Horseshoe kidney– Kidney may be found in the pelvis– Double ureters

• Ureters – muscular tubes extending from the renal pelvis to the bladder– Retroperitoneal– Attach to the bladder

• Stones (syn. Calculi, nephrolithiasis, or kidney stones)– Junction of ureters and renal pelves (pl.)– Where ureters cross the brim of the pelvic inlet– Where ureters pass through the wall of the

bladder

• Bladder– Hollow muscular viscus– Walls of the bladder are composed of muscle– As urine fills the bladder, stretch receptors in the

muscle wall respond– With relaxation, urine passes through the sphincter

into the urethra and outside the body• Male – urine left in the urethra is ejected by

contraction of muscles located in the perineum• Female – urethra is fairly short, explains why females

more easily get bladder infections

• Testicles (sperm production, contained in scrotum)• Duct system (transport sperm)

– Epididymis– Vas deferens

• Accessory glands (contribute to ejaculate)– Seminal vesicles– Prostate gland

• Penis– shaft– glans– prepuce

Anatomy: Male Reproductive System

Look primarily to 580-629• Listed anatomically– Kidney– Ureters– Bladder– Urethra

ICD-9-CM: Urinary

Inflammation• Nephritis (583)• Glomerulonephritis (580-582)

• Renal failure (584-586)

• CKD (585)– ESRD (585.6)– With hypertension (403-405)

ICD-9-CM: Urinary

• Disorders resulting from impaired renal function (588)– Report underlying condition first

• Nephrogenic diabetes insipidus (588.1)• Small Kidney (589)

– Uni- or bi-lateral– Congenital or by blockage/disease

• Infections of the Kidney (590)– Identify responsible organism– Pyelonephritis (590.0x, 590.1x, 590.8x)

ICD-9-CM: Urinary

• Hydronephrosis (591)– Fluid accumulation due to obstruction

• Calculi (stones)– Kidney and ureter (592)– Lower urinary tract (594)– Prostatic calculus (602.0)

• Acquired cyst(s) of kidney (593.2)– Congenital (753.1x)

ICD-9-CM: Urinary

• VUR (593.7x)– Backflow or urine into ureter

• Cystitis (595)– Bladder inflammation

• Bladder disorders (596)– Urinary incontinence (788.3x)

• UTI (599.0)– Report organism, when known

ICD-9-CM: Urinary

Look primarily to 600-608• Listed anatomically

– Prostate– Testes– Penis

Also…• Congenital Anomalies • Neoplasms• Signs/Symptoms

ICD-9-CM: Male Genital Organs

• BPH (600)– Enlarged prostate

• Hyperplasia (600.2x-600.9x.)• Prostatitis (601)• PSA (790.93)

– Elevated prostate specific antigen• Dysplasia

– PIN III (233.4)– PIN I or II (602.3)

• Hyrdocele (603)– Accumulation of serous fluid

• Orchitis (604)– Inflammation of testes

• Phimosis (605)– Narrowing of preputial orifice

• Balanitis (607.1)– Inflammation of foreskin

• Routine circumcision (V50.2)

• Male infertility (606)– Azoospermia– Oligospermia– Extratesticular

• Peyronie’s disease (607.85)

• Congenital Anomalies (752-753)– Cryptorchidism (752.51)– Hypospadias (752.61)– Epispadias (752.62)

• Neoplasms (by location)– e.g., Bladder cancer or prostate cancer– V76.44 Screening for malignant neoplasm of

prostate• Injury (866-867)• Signs and Symptoms (788-789)

50010-53899• Arranged by location/procedure type

– Incision, excision, repair, etc.

• Bilateral vs. Unilateral

• Operating Microscope (69990) may be separate

• Surgical endoscopy always includes diagnostic endoscope

CPT®: Urinary

Incision• “otomy”– Nephrotomy (50045) = incision of kidney– Pyelotomy (50120-50135) = incision of renal

pelvis– Nephrolithotomy (50060-50075)

• Incision to remove calculi– Percutaneous removal of calculi (50080-50081)

• Nephrostomy tract (50395)

CPT®: Kidney

• Excision– “-ectomy”– e.g., nephrectomy (50234, 50236)– Radical

• Supporting or adjacent structures• Areas of lymph nodes are taken

– Ablation

CPT®: Kidney

Introduction (aspiration, injection, instillation) (50382-50398)

• Ureteral stents– Percutaneous (50382-50384)– Transurethral (50385-50386)– Externally accessible (50387)

• Pyelography (50392-50394)• Manometric Studies (50396)• Tube change (50398)

CPT®: Kidney

Repair (50400-50540)• “-orrhaphy” “-pexy” “-ostomy”• Inpatient only

Laparoscopy (50541-50549)• Code by procedure• Not covered in ASC

Endoscopy (50551-50580)• Performed through natural or created opening• eg, renal endoscopy (50551)

CPT®: Kidney

• Lithotripsy (50590)– Crushing of calculi (stones)

• Percutaneous ablation of renal tumors (50592)

• Cryotherapy for renal tumors (50593)

CPT®: Kidney

• Incision– For insertion of stent (50605)– 50610-50630 (open), watch for location

• Stent via cystoscopy (52332)

• Excision (50650-50660)– Typically for ureteral cancer

CPT®: Ureter

• Introduction (50684-50690)• Repair (eg, for stricture, inflammation, injury)– Revision of urinary-cutaneous anastomosis

(50727)

• Laparoscopy (eg, 50947, 50948) • Endoscopy (50951-50980)– Examination of renal and ureteral structures– Code by approach

CPT®: Ureter

BladderIncision• eg, cystotomy, cystostomy, cystolithotomy

Removal (51100-51102)• Aspiration

CPT®: Bladder

Excision/cystectomy (51500-51597)• Diverticulum vs. tumorIntroduction (51600-51720)• Injection with X-ray (51600-51610)• Insertion of bladder catheter (51701-51703)• Cystostomy tube change (51705-51710)• Irrigation/instillation (51700)

CPT®: Bladder

Urodynamics• CMG (51725-51729, 51797)– Pressure studies are separately reported

• Uroflowmetry (51736-51741)• EMG (51784-51785)• Evoked response (51792)• Ultrasonography (51798)

CPT®: Bladder

Repair (51800-51980)• Urethropexy

– Marshall-Marchetti-Krantz (MMK) or Burch (51840-51841) – inpatient only

– Stress urinary incontinence (SUI)– Closure of fistulas

• Colposuspension• Sling procedures (57288)

– Female specific

CPT®: Bladder

Laparoscopy (51990-51999)• Incontinence – Surgical laparoscopic approach for SUI (51990,

51992)

Endoscopy (52000-52010)• Code by location (ureter, pelvis, vesical neck,

prostate)

CPT®: Bladder

Transurethral Surgery (52204-52355)• Biopsy (52204)• Cystourethroscopy

– 52270 female specific– 52275 male specific

• Female urethral syndrome (52285)• Ureteral strictures (52341-52346)• Ureteral/renal pelvic tumors (52351-52355)

CPT®: Urinary

Vesical Neck and Prostate (52400-52700)– Be aware of gender specification

• Resection of bladder neck (52500)– Often bundled to more complex procedure

• TURP (e.g., 52601)• Laser coagulation of prostate (52647)• Greenlight laser w/ TURP (52648)• Contact laser vaporization (52649)

CPT®: Urinary

Male (53000-53899)• Prostatic• Membranous• PenileIncision• Urethrotomy (53000-53010)• Meatotomy (53020/50325)• Skene’s Glands (53060/53270)

CPT®: Urethra

Excision• Total excision of urethra w/ cystostomy

– Female specific (53210)– Male specific (53215)

• Excision of diverticulum– Female (53230)– Male (53235)

• Excision of Cowper’s gland(53250)– Male specific

CPT®: Urethra

Repair (53400-53520)• Urethroplasty

– Type of repair– Gender

• Sling for incontinence (53440-53442)– Male specific

• Urethrorrhaphy– Female (53502)– Male (53505-53515)

CPT®: Urethra

Manipulation (53600-53665)

Other Procedures (53850-53899)• Transuretheral prostate destruction (53850-

53852)– Male specific

• Temp. prostatic stent (53855)

CPT®: Urethra

Penis (54000-54450)• Incision (54000-54015)• Destruction (54050-54065)• Excision (54100-54164)

– Excision of plaque (54110-54112)– Penectomy (54120-54135)– Circumcision (54150-54161)

• Introduction (54200-54250)• Repair (54300-54440)

– Hypospadia/epispadia (54300-54390)– Prosthesis (54400-54417)

• Manipulation (54450)

CPT®: Male Genital System

Testis (54500-54699)• Biopsy (54500-54505)– Test sperm production

• Orchiectomy (removal)/orchiopexy (repair)– By abdominal laparoscope (54690-54692)

• Orchiopexy– By approach

• Epididymis (54700-54901)• Tunica Vaginalis (55000-55060)• Scrotum (55100-55180)• Vas Deferens (55200-55450)• Spermatic Cord (55500-55559)• Seminal Vesicles (55600-55680)

Prostate• Biopsy (55700)– w/ imaging guidance (76942 in addition)

• Both professional (26) and technical (TC) components

• Excision (55801-55845)– Code by approach, lymph node involvement

• Other procedures (55870-55899)– treatments for malignancy

Reproductive System Procedures Male Reproductive system

• 55920 Placement of needles or catheters into pelvic organs and/or genitalia (except prostate for subsequent interstitial radioelement application

• Catheter supplies• Drugs for prostate cancer• Drugs for decreased testosterone

HCPCS Level II

• 50 – Bilateral procedures• 52 – Reduced services• 58 – Staged/related during global period• 76 – Repeat procedure by same physician or

other qualified health care professional

Modifiers

The End

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